Factors Associated with the Changes in Activities of Daily Living in Older Adults with Stroke: A Comparison of Home Care and Institutional Care

PURPOSE: To compare the changes in activities of daily living (ADLs) in older adults with stroke in different modalities of long term care (LTC) services, which include home care and institutional care. METHODS: This is a comparative study using secondary data from the Korean national LTC insurance. Home care (HC) services users (n=3,494) and institutional care (IC) users (n=1,428) were extracted and compared in terms of ADLs and changes in ADLs to investigate the effects of HC and IC services in LTC. RESULTS: All of the ADLs and LTC services benefit levels for 2 years had improved in both HC and IC services. The ADLs of older adults with stroke who received HC improved, while those who received IC experienced deterioration. The LTC services benefit levels of the HC and IC groups were significantly different after 2 years. CONCLUSION: The study has found that HC services may lead ADLs better for older adults with stroke. We recommend LTC policy makers to further develop HC and IC service programs to deliver quality LTC services.

Factors Associated with Metabolic Syndrome and Related Medical Costs by the Scale of Enterprise in Korea

OBJECTIVES: The purpose of this study was to identify the risk factors of metabolic syndrome (MS) and to analyze the relationship between the risk factors of MS and medical cost of major diseases related to MS in Korean workers, according to the scale of the enterprise. METHODS: Data was obtained from annual physical examinations, health insurance qualification and premiums, and health insurance benefits of 4,094,217 male and female workers who underwent medical examinations provided by the National Health Insurance Corporation in 2009. Logistic regression analyses were used to the identify risk factors of MS and multiple regression was used to find factors associated with medical expenditures due to major diseases related to MS. RESULT: The study found that low-income workers were more likely to work in small-scale enterprises. The prevalence rate of MS in males and females, respectively, was 17.2% and 9.4% in small-scale enterprises, 15.9% and 8.9% in medium-scale enterprises, and 15.9% and 5.5% in large-scale enterprises. The risks of MS increased with age, lower income status, and smoking in small-scale enterprise workers. The medical costs increased in workers with old age and past smoking history. There was also a gender difference in the pattern of medical expenditures related to MS. CONCLUSIONS: Health promotion programs to manage metabolic syndrome should be developed to focus on workers who smoke, drink, and do little exercise in small scale enterprises.

Influencing Factors for and Medical Expenditures of Metabolic Syndrome among Public Officials / 한국직업건강간호학회지

PURPOSE: This study examined the influencing factors for metabolic syndrome and the annual medical expenditures of metabolic syndrome among public officials. METHODS: The National Health Insurance data in 2009 were collected for 364,932 public officials and the heath examination results and annual medical expenditures were analyzed using PASW 18.0 program. RESULTS: The prevalence of metabolic syndrome is 17.6%, and it was higher in male officials than that of females in all age groups. In men, the influencing factors for metabolic syndrome were: age, family history of stroke, cardiovascular disease, hypertension, and diabetes mellitus, smoking, alcohol consumption, exercise, and obesity. However, in women, health-related behaviors such as smoking, alcohol consumption and exercise did not affect metabolic syndrome. People who had metabolic syndrome showed significantly higher medical expenditures than those without metabolic syndrome. The odds ratios of having the highest quartile in medical expenditures were 1.372 (95% CI 1.252~1.504, p<.001) in women with metabolic syndrome and 1.213 (95% CI: 1.184~1.243, p<.001) in men. CONCLUSION: The results implied that health-related behaviors were associated with metabolic syndrome, and resulted in higher medical expenditures. In order not only to decrease the risk of metabolic syndrome but also reduce medical expenditures, nurses should plan health promotion strategies to educate public officials about healthy life strategies.

Evaluation of the Effects of a Frailty Preventing Multi-factorial Program Concentrated on Local Communities for High-risk Younger and Older Elderly People

PURPOSE: The purpose of this study is to evaluate the effects of a local community based multi-factorial program for high-risk younger and older elderly people. METHODS: The quasi-experimental research design (pretest-post test) was employed. Participants were recruited in Seoul and a total of 98 elders completed an 8-week multi-factorial program for preventing frailty. Descriptive statistics, chi2-test and GLM were used in the data analysis with SPSS/WIN 15.0. RESULTS: The high-risk elderly people in the younger and older stages showed differences in IADL, TUG and BMI, and after being provided with the multi-factorial program for preventing frailty, some effects were shown on improving the total score of frailty, a physical function, TUG, BMI, depression, subjective feeling of health, and social interaction. CONCLUSION: The 8-week multi-factorial program for preventing frailty had positive effects on improving physical, emotional and social functions of the high-risk elderly people. It is necessary to evaluate the effects after individual intervention as well as group intervention and to evaluate the effects of the program by setting a control group in the future.

Factors Affecting Perceived Financial Burden of Medical Expenditures / 간호행정학회지

PURPOSE: This study was done to investigate factors affecting perceived financial burden of medical expenditures. METHOD: The participants were 2,024 inpatients who were enrolled in a survey on the benefit coverage rate of the National Health Insurance in 2006. The collected data were analyzed using t-test, ANOVA-test, Mann-Whitney-test, Kruskal-Wallis-test, Chi-square test and logistic regression. RESULTS: The crucial factors for perceived financial burden were age, job, equivalence scale, ratio of annual family income vs medical expenditure, and private health insurance. Perceived financial burden was higher for people who were older, who were unemployed, whose medical expenditures were high compared to annual family income, whose index of family equalization was low and for those who had no private health insurance. CONCLUSION: The results of the study indicate a demand for system reform that will enable management of no-pay hospital bills in the National Health Insurance to decrease the medical expense of people in the low-income bracket.

The Influencing Factors of Influenza Vaccination in the Elderly Participating in Lifetime Transitional Health Examination

PURPOSE: The purpose of this study was to investigate the influencing factors of influenza vaccination in the elderly participating in lifetime transitional health examination. METHODS: This study was a secondary analysis of data collected from lifetime transitional health examination (for 66-year-old people) conducted by the National Health Insurance Corporation (NHIC) from January 1 to December 31, 2008. Questionnaires were received from NHIC to obtain information regarding gender, chronic diseases, health-related behaviors, and ADL. A total of 255,333 participants who responded all the questions in the questionnaire were included in the analysis. Collected data were analyzed by descriptive statistics, chi2 test, and multiple logistic regression. RESULTS: The influenza vaccine coverage rate in 66-year-old people was 66.1%. The influenza vaccine coverage rate was higher in female elders and those with hypertension, diabetes, heart disease or past smoking, and lower in those with stroke, current smoking, drinking, no-exercise or ADL-dependency. CONCLUSION: Strategies for improving the influenza vaccination coverage rate in the elderly are needed. The strategies should give priority to the elderly with current smoking, drinking, and no-exercise, and home visiting programs are needed for the elderly with stroke and ADL-dependency.

The Effects of Related Factors on Health-related Quality of Life for the Frail Elderly

PURPOSE: The purpose of this study was to identify the predictors of health-related quality of life and to examine their effects in frail elderly. METHODS: This was a correlation study. The subjects were 680 frail elders aged over 65 who were receiving home care from one of 253 public health centers in 16 provinces, and data were collected from the 1st to 30th of April, 2008. RESULTS: The mean health-related quality of life in the subjects was 6.0+/-2.0. The predictors identified in this study significantly explained 41.3% of health-related quality of life. Self-rated health was the most significant predictor of health-related quality of life. ADL and depression had an effect on health-related quality of life. CONCLUSION: Self-rated health, ADL and depression were the predictors of health-related quality of life in the frail elderly.

The Effects of Customized Home Visiting Health Service in Gangwon-do: Focused on Hypertension and DM Clients

PURPOSE: This study was to present the effects of home visiting health service on hypertension and DM clients. METHOD: The one-group pretest-posttest design was applied to 127 hypertension and 116 DM clients. To evaluate the effects of visiting nursing service, biological indexes and self-care abilities were measured from April to July, 2007. RESULT: Biological indexes and self-care abilities were improved in the hypertension and DM clients who received visiting nursing service. Especially, blood pressure and fasting blood sugar showed a dramatic decrease. CONCLUSION: Home visiting health service by public health centers is considered to be an effective nursing service in Gangwon-do. Therefore, case management is demanded not only for hypertension and DM but also for other chronic diseases.

Factors Influencing Children's Immunization

No abstract available.

An Analysis of Related Factors for Major Nursing Diagnoses Identified for Instituionalized Elders / 성인간호학회지

PUPPOSE: The purpose of this study was to analyze related factors for major nursing diagnoses used in caring for institutionalized elders. METHOD: This study was a descriptive study. The participants were 92 residents in a long-term care facility in Wonju, selected by convenience sampling. The instrument was a checklist designed on the basis of the related factors suggested by NANDA (1997) and a literature review. Data was collected by chart review, observation, and interviews with the participants. Data was analyzed using descriptive statistics with the SPSS WIN program. RESULT: The most frequent nursing diagnosis was 'risk for injury', 'self-esteem disturbance', 'activity intolerance', 'impaired phyical mobility', and 'powerlessness'. The most frequent component for related factors for the five component for each nursing diagnosis was the physical component, followed by the social component. Common related factors for the nursing diagnoses were 'pain', 'change of emotional state/disorder', 'cognitive disorder', 'change of physical structure and function', and 'physical impairment', and 'immobility'. CONCLUSION: The results of this study can contribute to the development of appropriate nursing intervention programs for elders (eg. 'Injury Prevention Programs', 'Self-esteem Improvement Programs' etc.). Clinical guidelines that gerontological nurses can use to accurately assess health problems and select appropriate nursing interventions may be developed.

Clinical Nurses' lived Experience of Interpersonal Relations in the Ward Setting of the hospital / 간호학회지

PURPOSE: The purpose of the study was to describe the essential structure of the lived experience of clinical nurses' interpersonal relations among nurses, patients, and others in the ward setting of the hospital. METHOD: Six nurses who have experienced from 4 to 7 years on the same ward setting, were interviewed. The data were collected from September, 2000 to May, 2001 and analyzed using Colaizzi's (1978) method of phenomenology. RESULT: In this study, 7 themes were extracted: difficulty of interpersonal relations after being familiar with work, developing good relations with doctors, patients, and their significant others as experience increased, generation gap among individual nurses, evaluating other nursing colleagues on their past experience in ward settings, avoiding nurses with whom one was in conflict, sometimes, resolving conflict through getting together with colleagues informally, having a limited interpersonal network, experiencing becoming mature through struggling with the difficulty of interpersonal relations. CONCLUSION: Nurse managers need to provide resources, opportunities, and information to clinical nurses through fully understanding the characteristics of nurses' interpersonal relations. In addition, they should minimize the factors which intervene with good interpersonal relations among clinical nurses.